Acceptability of the Distress Thermometer and Problem List to community-based telephone cancer helpline operators, and to cancer patients and carers

Operators (n = 18) monitored usage of the DT and PL with callers (cancer patients/carers, >18 years, and English-speaking) from September-December 2006 (n = 666). The DT is a single item, 11-point scale to rate level of distress. The associated PL identifies the cause of distress.The DT and PL were used on 90% of eligible callers, most providing valid responses. Benefits included having an objective, structured and consistent means for distress screening and triage to supportive care services. Reported challenges included apparent inappropriateness of the tools due to the nature of the call or level of caller distress, the DT numeric scale, and the level of operator training.We observed positive outcomes to using the DT and PL, although operators reported some challenges. Overcoming these challenges may improve distress screening particularly by less experienced clinicians, and further development of the PL items and DT scale may assist with administration. The DT and PL allow clinicians to direct/prioritise interventions or referrals, although ongoing training and support is critical in distress screening.Cancer can be a distressing experience for cancer patients and carers, impacting on psychological, social, physical and spiritual functioning [1-9]. Between 10-50% of patients and carers suffer from ongoing, clinically significant psychological morbidity [6,8,10-12]. Health professionals often fail to detect distress in their patients [12] due to time constraints, and a lack of confidence in assessing distress and using psychometric instruments [13]. Also, with the focus on the patient, carer needs are often overlooked and only 50% of those with serious psychological distress will seek support [3,6].In an effort to address barriers to distress screening, the National Comprehensive Cancer Network (NCCN) recommends the distress thermometer (DT), a single-item self-report measure of distress [14]. The DT is reportedly a brief, non-invasive, valid and acceptable alter